exhibit 1. comparative analysis of ehb benchmark plans - ct.gov
TRANSCRIPT
Exhibit 1. Comparative Analysis of EHB Benchmark Plans
State Employee
Plans
Largest HMO
ConnectiCare
Ambulatory Patient ServicesProviders
Primary Care Providers Y Y Y Y Y Y Y
Family/General Y Y Y Y Y Y Y
Internal Medicine Y Y Y Y Y Y Y
OB/Gyn Y Y Y Y Y Y Y
Specialist Physicians Y Y Y Y Y Y Y
Other Covered Provider
Nurse Midwife
Y Y Y
Y
home birth not
covered Y Y Y
Chiropractor
Y
Y
20 visits per yr YY
20 visits/year Y
Y
1 office vist/year, 1 x-
ray, 12
osteopathic/chiropract
ic manipulations/year
Y
1 office vist/year, 1 x-
ray, 12
osteopathic/chiropract
ic manipulations/year
Osteopath
Y y Y unknown Y
Y
12 manipulations/year
Y
20
osteopath/acupunctur
e visits/year
Acupuncturist
Y N N
Y
24 visits/year
Y
20
osteopath/acupunctur
e visits/year
Naturopath Y Y Y unknown Y N N
Audiologist
Y Y Y
Y
as part of Birth-to-
Three Program
Y
as part of Birth-to-
Three Program
Y
treatment related to
illness/injury
Y
treatment related to
illness/injury
Nurse Anesthesiologist Y Y Y Y Y Y Y
Physician Assistant Y Y Y Y Y Y Y
Certified Surgical Assistant Y Y Y Y Y Y Y
Service
Small Group PlansFederal Employee Plans
Oxford PPO
Anthem BCBS
HMO Aetna HMO
BCBS Standard
and Basic
GEHA Standard
OptionAnthem HMO
Legend: Y = Covered, N = Not Covered, Y* = Probably Covered, N* = Probably Not Covered1 of 15
Exhibit 1. Comparative Analysis of EHB Benchmark Plans
State Employee
Plans
Largest HMO
ConnectiCare Service
Small Group PlansFederal Employee Plans
Oxford PPO
Anthem BCBS
HMO Aetna HMO
BCBS Standard
and Basic
GEHA Standard
OptionAnthem HMO Optometrist
Y Y YY
1 exam/year
Y
1 exam/year
Y
exams related to
specific medical
condition, also offerd
as ridered benefit Y
Nurse Practitioner/Clinical Specialist Y Y Y Y Y Y Y
Christian Science Practitioner
unknown unknown N*
Y
50 vists/year, 30 days
nursing care/year
Biofeedback unknown N N N unknown N N
Hypnotherapy unknown unknown unknown N unknown N N
Clinical Ecology unknown unknown unknown unknown unknown N* N
Environmental Medicine unknown unknown unknown unknown unknown N* N
Services
Outpatient Surgery Physician/Surgical Services Y Y Y Y Y Y Y
Operative Procedures Y Y Y Y Y Y Y
Treatment of Fractures, Including Casting Y Y Y Y Y Y Y
Correction of Amblyopia and Strabismus
Y Y Y unknown
Y*
orthoptics are covered
for convergence
insufficiency and
amblyopia
penalization patching
for childrend Y Y
Endoscopy Procedures Y Y Y Y* Y Y Y
Biopsy Procedures Y Y Y Y* Y Y Y
Removal of Tumors and Cysts Y y y Y Y Y Y
Voluntary Sterilization
Y
reversal not covered
Y
reversal not covered
Y
reversal not covered Y
Y
reversal not covered Y Y
Surgically Implanted Contraceptives
Y Y Y N
Y
must be performed
during annual well
woman visit Y Y
Legend: Y = Covered, N = Not Covered, Y* = Probably Covered, N* = Probably Not Covered2 of 15
Exhibit 1. Comparative Analysis of EHB Benchmark Plans
State Employee
Plans
Largest HMO
ConnectiCare Service
Small Group PlansFederal Employee Plans
Oxford PPO
Anthem BCBS
HMO Aetna HMO
BCBS Standard
and Basic
GEHA Standard
OptionAnthem HMO Termination of Pregnancy
Y Y Y
N*
family planning
services listed among
exclusions Y
Y
only to preserve the
life of mother/cases of
rape or incest
Y
only to preserve the
life of mother/cases of
rape or incest
Treatment of Burns Y Y Y Y* Y Y Y
Pre-Surgical Testing
Y Y Y Y Y
Y
within one business
day of covered surgical
service Y
Anesthesia Y Y Y Y Y Y Y
Physician Services Y Y Y Y Y Y Y
Office Medical Consultations Y Y Y Y Y Y Y
Infertility Diagnosis Y Y Y Y Y Y Y
Infertility Treatment Y Y Y Y N N
Pharmacotherapy unknown unknown unknown N* N* Y Y
Second Surgical Opinions Y Y Y unknown Y Y Y
Telehealth unknown unknown unknown unkonwn unknown Y Y
Separately Billed OP Facility Services
Routine Vision Exams
Y Y Y
N*
w/out Vision Care
Rider screening only
for children or
diabetics
Y
IN: 1 visit/year;
OON: 1 visit/2 years N N
Routine Hearing Exams
Y Y YN*
only for children Y N N
Operating, Recovery, Observation, and Other
Treatment Rooms Y Y Y Y Y Y Y
Chemotherapy/Radiation Therapy Y Y Y Y Y Y Y
IV/Infusion Therapy Y Y Y Y Y Y Y
Dialysis Y Y Y Y Y Y Y
Respiratory/inhalation therapy Y Y Y Y Y Y Y
Medical Supplies, Including Oxygen Y Y Y Y Y Y Y
Dental - Diagnostic/Preventive N N N N N Y Y
Legend: Y = Covered, N = Not Covered, Y* = Probably Covered, N* = Probably Not Covered3 of 15
Exhibit 1. Comparative Analysis of EHB Benchmark Plans
State Employee
Plans
Largest HMO
ConnectiCare Service
Small Group PlansFederal Employee Plans
Oxford PPO
Anthem BCBS
HMO Aetna HMO
BCBS Standard
and Basic
GEHA Standard
OptionAnthem HMO Dental - Restorative
N N N N N*
Y
inlays, amalgams/resin
resotations, pin
retention, space
maintenance
Y
inlays, amalgams/resin
resotations, pin
retention, space
maintenance
Routine Foot Care
N*
except for diabetics
N*
except for diabetics
N*
except for diabetics
N*
except for diabetics
N*
except for diabetics
Y
metabolic/peripheral
vascular disease (eg.
diabetes) only
Y
metabolic/peripheral
vascular disease (eg.
diabetes) only
Emergency ServicesProviders
Emergency Room Services Y Y Y Y Y Y Y
Emergency Transportation/Ambulance Y y Y Y Y Y Y
Local Ambulance
Y Y Y Y Y Y
Y
within 100 miles
Air Ambulance
Y Y Y Y Y Y
Y
covered when ground
ambulance not
available or
apprioriate
Urgent Care Centers or Facilities Y Y Y Y Y Y Y
Outside Hospital (Paramedics Care, Mobile Field
Hospital, etc.) Unknown Unknown Unknown Y Y Y Y
Services
Outpatient Physician Care
Y Y Y Y Y Y
Y
within 72 hours
Non-Surgical Physician Services and Supplies Y Y Y Y Y Y Y
Surgical Care Y Y Y Y Y Y Y
HospitalizationProviders
Inpatient Hospital Services (e.g. Hospital Stay) Providers
Y Y Y Y Y Y Y
Inpatient Non-Hospital
Home Health Care Services
Y Y YY
100 visits/year
Y
200 visits/year
Y
25 vists upto 2 hours
each
Y
50 inhome vists/year
Home Health Aids
Y
Y
80 visits/yearY
100 visits/year unknown unknown
Y
80 visits/year
Legend: Y = Covered, N = Not Covered, Y* = Probably Covered, N* = Probably Not Covered4 of 15
Exhibit 1. Comparative Analysis of EHB Benchmark Plans
State Employee
Plans
Largest HMO
ConnectiCare Service
Small Group PlansFederal Employee Plans
Oxford PPO
Anthem BCBS
HMO Aetna HMO
BCBS Standard
and Basic
GEHA Standard
OptionAnthem HMO
Hospice
Y Y Y Y
Y
IN: unlimited
OON: 60 visits/year Y Y - $15,000 maximum
Services
Inpatient Surgical Services
Reconstructive Surgery (Excluding Cosmetic) Y Y Y Y Y Y Y
Obesity Surgery
N
Y
with prior auth. N
unknown
abdominoplasty,
lipectomy and
panniculectomy not
covered unknown
Y
Bariatric Surgery:
morbid obesity
diagnosis for 2+ years
and other
authroziation
requirements; Gastric
Restrictive
Procedures: age 18+
with restrictions
Y
Bariatric Surgery:
morbid obesity
diagnosis for 2+ years
and other
authroziation
requirements; Gastric
Restrictive
Procedures: age 18+
with restrictions
Temporomandibular disorders (TMD)
N N N
N*
only surgical
treatment covered N Y Y
Transplants - Human Organ/Tissue
Cornea Y Y Y Y Y Y Y
Heart Y Y Y Y Y Y Y
Simultaneous Heart/Lung Y Y Y Y Y Y Y
Intestinal Y Y Y Y Y Y Y
Kidney Y Y Y Y Y Y Y
Liver Y Y Y Y Y Y Y
Lung Y Y Y Y Y Y Y
Pancreas Y Y Y Y Y Y Y
Bone Marrow Y Y Y Y Y Y Y
Stem Cell Y Y Y Y Y Y Y
Autologous Pancreas Islet Cell Y Y Y unknown unknown Y unknown
Transplants - Artificial Organ Implant Y Y Y unknown N N Y
Correction of Congenital Anomalies
Y Y Y Y Y Y
Y
18 and under only
(unless there is a
functional deficit)
Home Health Aids
Y
Y
80 visits/yearY
100 visits/year unknown unknown
Y
80 visits/year
Legend: Y = Covered, N = Not Covered, Y* = Probably Covered, N* = Probably Not Covered5 of 15
Exhibit 1. Comparative Analysis of EHB Benchmark Plans
State Employee
Plans
Largest HMO
ConnectiCare Service
Small Group PlansFederal Employee Plans
Oxford PPO
Anthem BCBS
HMO Aetna HMO
BCBS Standard
and Basic
GEHA Standard
OptionAnthem HMO Insertion of Internal Prosthetic Devices Y Y Y Y Y Y Y
Anesthetics Y Y Y Y Y Y Y
Inpatient Physician/Other Services
Physician Visits Y Y Y Y Y Y Y
Nursing Y Y Y Y Y Y Y
Administration of Blood, Plasma, and other Biologicals
Y Y Y Y Y Y Y
Medical Supplies Y Y Y Y Y Y Y
Pre-Admission Testing Y Y Y Y Y Y Y*
Hospice Specific Services
Dietary Counseling Y Y Y Y* unknown Y unknown
Durable Medical Equipment Y Y Y Y* Y* Y Y*
Medical Social Services (Counseling)
Y Y Y Y*
Y
5 visits for counseling Y Y*
Private Duty Nursing N N N Y* Y N N
Oxygen Therapy Y Y Y Y* Y Y Y*
Home Health Aids
unknown unknown unknown
Y
for all Hospice Care
(<6mon expectancy),
plan maximums do
not apply Y Y Y*
Respite Care
unknown unknown unknown unknown N
Y
max 7 consecutive
days/occurrence Y*
Maternity and Newborn CareProviders
Inpatient Hospital Providers Y Y Y Y Y Y Y
OB/Gyn Y Y Y Y Y Y Y
Nurse Midwife unknown unknown unknown Y Y Y Y
Lactation Consultant
unknown unknown unknown
Y
1 home visit Y Y Y*
Alternative Birthing Center
Y
Y*
must have partnership
with carrier Y* Y*
Services
Legend: Y = Covered, N = Not Covered, Y* = Probably Covered, N* = Probably Not Covered6 of 15
Exhibit 1. Comparative Analysis of EHB Benchmark Plans
State Employee
Plans
Largest HMO
ConnectiCare Service
Small Group PlansFederal Employee Plans
Oxford PPO
Anthem BCBS
HMO Aetna HMO
BCBS Standard
and Basic
GEHA Standard
OptionAnthem HMO Prenatal Care
Childbirth Classes unknown unknown unknown unknown unknown unknown unknown
Laboratory/Diagnosis
Y Y Y Y Y
Y
excludes genetic
testing/screening for
father Y*
Ultrasound Y Y Y Y Y Y Y
Tocolytic Therapy unknown unknown unknown unknown unkonwn Y Y
Postnatal Care Y Y Y Breastfeeding Education
Y Y YY
1 home visit y Y Y*
Mental Health Treatment for Postpartum Depression Y
MH Parity y y unknown Y
Y
4 visits/year Y*
Delivery and Inpatient Services for Maternity
Delivery Y Y Y Y Y Y Y
Nursery Care Y Y Y Y Y Y Y
Mental Health and Substance Use Disorder ServicesProviders
Psychiatry Y Y Y Y Y Y* Y
Psychology
Y Y unknown
N*
covered only in
residential treatment
facility when provided
by physician
practicising as
psychologist Y Y
Clinical Social Worker
Y Y Y unknown
N*
covered only in
residential treatment
facility when provided
by physician
practicising as social
worker Y Y
Legend: Y = Covered, N = Not Covered, Y* = Probably Covered, N* = Probably Not Covered7 of 15
Exhibit 1. Comparative Analysis of EHB Benchmark Plans
State Employee
Plans
Largest HMO
ConnectiCare Service
Small Group PlansFederal Employee Plans
Oxford PPO
Anthem BCBS
HMO Aetna HMO
BCBS Standard
and Basic
GEHA Standard
OptionAnthem HMO Professional Counselor
Y Y Y unknown
N*
covered only in
residential treatment
facility when provided
by physician
practicising as
professional counselor Y* Y
Marriage and Family Therapist
N* N* N* unknown
N*
covered only in
residential treatment
facility when provided
by physician
practicising as
professional
counselor; marital
counseling not
covered N N
Services
Mental/Behavioral Health Inpatient Services
Pharmacotherapy Unknown Unknown Unknown Y Y Y
Psychological Testing
Y Y Y
Y
excludes testing for
mental retardation,
learning disorders,
motor skills disorder,
communication
disorders, caffeine
related disorders,
relational problems
Y
excludes testing for
learning disabilities or
mental retardation Y
Electroconvulsive Therapy Unknown Unknown Unknown Y Y* Y
Treatment Y Y Y Y
Mental/Behavioral Health Outpatient Services Y Y Y Office Visits Y Y Y Y Y Y Y
Legend: Y = Covered, N = Not Covered, Y* = Probably Covered, N* = Probably Not Covered8 of 15
Exhibit 1. Comparative Analysis of EHB Benchmark Plans
State Employee
Plans
Largest HMO
ConnectiCare Service
Small Group PlansFederal Employee Plans
Oxford PPO
Anthem BCBS
HMO Aetna HMO
BCBS Standard
and Basic
GEHA Standard
OptionAnthem HMO Pharmacotherapy Unknown Unknown Unknown N Y Y
Psychological Testing
Y Y Y
Y
excludes testing for
learning disabilities or
mental retardation
Y
excludes testing for
learning disabilities or
mental retardation Y
Crisis Intervention/Acute Stabilization Y Y Y Y* Y* Y
Electroconvulsive Therapy Unknown Unknown Unknown Y* Y* Y
Substance Abuse Disorder Inpatient Services
Diagnosis Y Y Y Y Y Y Y
Detoxification Y Y Y Y Y* Y* Y
Treatment Y Y Y Y Y Y Y
Counseling Y Y Y Y Y* Y* Y
Substance Abuse Disorder Outpatient Services
Diagnosis Y Y Y Y Y Y Y
Detoxification Y Y Y Y Y* Y* Y
Treatment Y Y Y Y Y Y Y
Counseling Y Y Y Y Y* Y* Y
Prescription DrugsProviders Rx provided through
rider
Rx provided through
rider
Rx provided through
rider
Rx provided through
rider
Rx provided through
rider
Mail Order Service N N Y Y
Retail Service N N Y Y
Services
Generic/Brand Drugs N N Y Y
Specialty Drugs (Special Handling, Admin., Monitoring)
Y* N Y Y
Insulin and Needles for Diabetics Y Y Y Y
Contraceptive Drugs N N Y Y
Rehabilitative and Habilitative ServicesProviders
Legend: Y = Covered, N = Not Covered, Y* = Probably Covered, N* = Probably Not Covered9 of 15
Exhibit 1. Comparative Analysis of EHB Benchmark Plans
State Employee
Plans
Largest HMO
ConnectiCare Service
Small Group PlansFederal Employee Plans
Oxford PPO
Anthem BCBS
HMO Aetna HMO
BCBS Standard
and Basic
GEHA Standard
OptionAnthem HMO Licensed PT/OT/ST Therapist
Y Y Y Y
Y
PT/OT/Chiropractic
coverd
ST: Covered only for
treatment resulting
from autism, stroke,
tumor removal, injury
or congenital
anomalies of the or
pharynx Y Y
Physician Y Y Y Y Y Y Y
Inpatient Facility
Y Y Y Y Y
Y
Standard: 75 OP
vists/year; Basic: 50
OP visits/year
Y
60 PT/OT visits/year;
30 ST vists/year
Outpatient Facility
Y Y Y
Y
Standard: 75 OP
vists/year; Basic: 50
OP visits/year
Y
60 PT/OT visits/year;
30 ST vists/year
Massage Therapist N* N* N* N* unknown N N
Services
Rehabilitation Services
PT/OT/ST
Y
Y
30 combined
vists/year
Y
20 combined
vists/year
Y
40 combined
visits/year
Y
IN: unlimited;
OON: 30 OP
visits/year; 30 speech
visits/year
Y
Standard: 75 OP
vists/year; Basic: 50
OP visits/year
Y
60 PT/OT visits/year;
30 ST vists/year
Cognitive Rehabilitation Therapy
Y Y Y unknown
Y
Standard: 75 OP
vists/year; Basic: 50
OP visits/year unknown
Cardiac Rehab
Y Y Y
Y*
Phase I and Phase II
covered; Phase III if
criteria met; Phase IV
not covered Y Y Y
Massage Therapy
Unknown Unknown Unknown
N*
only when part of
PT/OT program unknown N unknown
Legend: Y = Covered, N = Not Covered, Y* = Probably Covered, N* = Probably Not Covered10 of 15
Exhibit 1. Comparative Analysis of EHB Benchmark Plans
State Employee
Plans
Largest HMO
ConnectiCare Service
Small Group PlansFederal Employee Plans
Oxford PPO
Anthem BCBS
HMO Aetna HMO
BCBS Standard
and Basic
GEHA Standard
OptionAnthem HMO Maintenance/Palliative Rehabilitation Therapy
Unknown Unknown Unknown
Y
pain management
covered
Y
pain management
covered N N
Habilitation Services
PT/OT/ST
Y Y COMBINED 30 VISITS Y COMBINED 30 VISITS
Y
40 combined
visits/year
Y
IN: unlimited;
OON: 30 OP
visits/year; 30 speech
visits/year
Y
Standard: 75 OP
vists/year; Basic: 50
OP visits/year
Y
60 PT/OT visits/year;
30 ST vists/year
Neurodevelopmental Therapy N* N* N*
Durable Medical Equipment, Prosthetics Y Y Y Oxygen Equipment
Y Y Y Y Y
Y
does not include
topical hyperbaric
oxygen therapy Y
Wheelchairs, Crutches, Walkers Y Y Y Y Y* Y Y
Home Dialysis Equipment Y Y Y unknown Y Y Y
Hearing Aids
Y - CHILDREN Y - CHILDREN Y - CHILDREN
Y/N
child < 12: max per ear
adults: not covered
Y/N
child < 12: max per ear
adults: not covered
Y
$1250 per ear for
children, and per 36
months for adults Y
Glasses/Contacts
N* N N* N N
Y
if required as a result
of injury/illness; also
offered as ridered
benefit
Y
one pair per aciddent,
condition, or to delay
surgery (eg.
amblyopia/strabismus
)
Exercise Equipment for Medically Necessary Condition
N* N N* N N N N
Artificial Limbs and Eyes Y Y Y Y Y Y
Repair/Maintenance of Approved Prosthetics
Y Y Y
Y
excludes
repair/replace due to
misuse/loss Y Y
Legend: Y = Covered, N = Not Covered, Y* = Probably Covered, N* = Probably Not Covered11 of 15
Exhibit 1. Comparative Analysis of EHB Benchmark Plans
State Employee
Plans
Largest HMO
ConnectiCare Service
Small Group PlansFederal Employee Plans
Oxford PPO
Anthem BCBS
HMO Aetna HMO
BCBS Standard
and Basic
GEHA Standard
OptionAnthem HMO Orthotics
Y N N
Y
medically necessary
orthotics
Y
medically necessary
orthotics
unkonwn
foot orthotics
excluded, others not
mentioned
Wigs for Hair Loss due to Chemotherapy N Y N y Y upto $350/year Y N
Ostomy Supplies
Y Y YY
up to $1000/year Y
Hypodermic Needles Y Y Y Y Y
Wound Care (for Epidermoysis Bullosa) Y Y Y Y Y
Breast Implants
Y
following mastectomy
Y
following mastectomy
Y
following mastectomy
Y
following mastectomy
Y
following mastectomy
Diabetic Equipment and Supplies Y Y Y Y
Laboratory ServicesProviders
Laboratory Y Y Y Y Y Y Y
Inpatient Facility Y Y Y Y Y Y Y
Outpatient Facility Y Y Y Y Y Y Y
Physician Y Y Y Y Y Y Y
Radiologists Y Y Y Y Y Y Y
Services Y Y Electrocardiograms (EKGs) Laboratory/Blood Tests
Y Y YY
1 test/year Y Y Y
Neurological Testing Y Y Y Y Y* Y Y*
Pathology Services Y Y Y Y* Y Y Y
Urinalysis Y
1 test/year Y Y Y
X-Rays Y Y Y Y Y Y Y
Electroencephalograms (EEGs) Y Y Y Y Y Y Y
Ultrasounds Y Y Y Y Y Y Y
CT scans/MRIs, PET Scans Y Y Y Y Y Y Y
Bone Density Tests
Y Y Y
Y
age 60 or older, 1
test/23 months Y Y Y
Diagnostic Angiography Y Y Y unknown Y Y Y
Genetic Testing - Diagnostic Y Y Y Y unknown Y Y
Nuclear Medicine Y Y Y Y Y Y Y
Legend: Y = Covered, N = Not Covered, Y* = Probably Covered, N* = Probably Not Covered12 of 15
Exhibit 1. Comparative Analysis of EHB Benchmark Plans
State Employee
Plans
Largest HMO
ConnectiCare Service
Small Group PlansFederal Employee Plans
Oxford PPO
Anthem BCBS
HMO Aetna HMO
BCBS Standard
and Basic
GEHA Standard
OptionAnthem HMOPolysomnography (Sleep Studies) Y Y Y Y Y Y Y
Preventive and Wellness Services and Chronic Disease ManagementProviders
Primary Care Provider Y Y Y Y Y
OB/Gyn Y Y Y
Services
Preventive Care/ Screenings for Adults Y Adult Physical Exam
Y
Y
ages 22-49: 1 visit/1-3
years
aged 50-64: 1
visit/year
Y
1 visit/year Y Y
Routine Gynecological Visit
Y Y
Y
1 visit/year Y Y
Nutritional Counseling
YY
2 visits/year unknown Y
Y
$250/year
Smoking Cessation Program unknown unknown unknown Y unknown Y Y
Health Risk Education/Counseling Y Y Y unknown unknown Y Y
Cancer Screening (Prostate, Breast, Colorectal, Cervical)
Y Y Y Y Y Y Y
Mammography
Y Y Y Y
Y
1 baseline for females
35-39; 1
screening/year for
female 40+
Cholesterol Screening Y Y Y Y Y Y
STI Screening
Y Y Y
Y
1 Chlamydia, Syphilis
and Gonorrhea
screening for
females/year; HIV
unlimited unknown Y Y
Osteoporosis Screening
Y Y Y Y
Y
women age 60+
Y
women age 65+ or
60+ and at additional
risk
CDC Recommended Immunizations Y Y Y Y Y Y Y
Legend: Y = Covered, N = Not Covered, Y* = Probably Covered, N* = Probably Not Covered13 of 15
Exhibit 1. Comparative Analysis of EHB Benchmark Plans
State Employee
Plans
Largest HMO
ConnectiCare Service
Small Group PlansFederal Employee Plans
Oxford PPO
Anthem BCBS
HMO Aetna HMO
BCBS Standard
and Basic
GEHA Standard
OptionAnthem HMO Diabetes Education
Y Y Y Y Y
Y
$250/year
Metabolic Panel
Y Y YY
1 test/year Y Y*
Genetic Counseling and Screening
Y Y Y
Y
BRCA counseling and
genetic screening for
women at risk Y
Y
BRCA screening
limited to cancer
diagnosis, counseling
for BRCA if screen is
positive N
Preventative Care/Screenings for Children
Well Child Care Y Y Y Y Y
CDC Recommended Immunizations
Y Y Y Y
Y
include immunizations
for travelling Y Y
STI Screening
Y Y Y Y unknown Y
Y
chlamydia screening
only
Pediatric Services (Including Oral and Vision Care)Providers
Pediatrician Y Y Y Y Y Y Y
Other Primary Care Provider Y Y Y Y Y Y Y
Services
Dental Check-Up for Children N N N N N Y Y
Vision Screening for Children
Y Y Y
Y
Plan includes Vision
Care Rider for
expanded beneifts Y Y Y
Eye Glasses for Children
N
Plan includes Vision
Care Rider for
expanded beneifts N
N*
one pair per aciddent,
condition, or to delay
surgery (eg.
amblyopia/strabismus
)
N*
if required as a result
of injury/illness; also
offered as ridered
benefit
Hearing Screening for Children Y Y Y Y Y Y Y*
Medical Foods for Children Y Y Y Y Y Y Y*
Legend: Y = Covered, N = Not Covered, Y* = Probably Covered, N* = Probably Not Covered14 of 15
Exhibit 1. Comparative Analysis of EHB Benchmark Plans
State Employee
Plans
Largest HMO
ConnectiCare Service
Small Group PlansFederal Employee Plans
Oxford PPO
Anthem BCBS
HMO Aetna HMO
BCBS Standard
and Basic
GEHA Standard
OptionAnthem HMO
Other ServicesAustism Spectrum Disorder
Behavioral Therapy Y Y Y Y Y
Outpatient Rehabilitation Y Y Y Y Y
Allergy Office Visit/Testing
Y Y 80 VISTS PER CAL YRY
up to $315/2 years Y
Allergy Injection Y Y Y
Diabetic Equipment and Supplies Y Y Y Y Y
Skill Nursing Facility
Y Y YY
90 visits Y
Experitmental Treatments Y Y Y Y Y
Lyme Disease Treatment Y Y Y Y Y
Diabetic Equipment and Supplies Y Y Y Y y
Blood Lead and Screening
Y Y YY
for children up to 6 y
Modified Food Products for Inhereited Metabolic
Diseases Y Y Y Y Y
Removal of Breast Implant (implanted before on
7/1994) Y Y Y Y Y
Notes:
Well Child Care visits include: 6 exams from birth to 1; 6 exams 1 through 5 years of age; 1 exam every year calendar year year 6 through 21
For all plans, "habilitative" not clearly spelled out
Cognitive Rehabilitation Therapy refers to recovering or learning to adjust after trauma to the brain
Legend: Y = Covered, N = Not Covered, Y* = Probably Covered, N* = Probably Not Covered15 of 15